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  • 1.
    Acheampong, Faustina
    et al.
    Högskolan i Jönköping, Internationella Handelshögskolan, IHH, Informatik.
    Vimarlund, Vivian
    Högskolan i Jönköping, Internationella Handelshögskolan, IHH, Informatik. Högskolan i Jönköping, Internationella Handelshögskolan, IHH, Centre for Information Technology and Information Systems (CenITIS). Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Innovating healthcare through remote monitoring: Effects and business model2017Inngår i: Health Care Delivery and Clinical Science: Concepts, Methodologies, Tools, and Applications, IGI Global, 2017, s. 247-268Kapittel i bok, del av antologi (Annet vitenskapelig)
    Abstract [en]

    Information technology has been suggested to improve patient health outcomes and reduce healthcare cost. This study explored the business model and effects of collaborative innovation between caregivers and patients on healthcare delivery through remote patient monitoring by interviewing caregivers and surveying atrial fibrillation patients. Findings indicate that remote monitoring enhanced early detection of potential risks and quality of clinical decision-making with patients feeling more empowered and involved in their own care. The remote monitoring system which consisted of a home-based ECG and a web-based service and was offered free to patients, brought together caregivers, patients, service provider and the government as actors. The introduction of remote monitoring increased the workload of caregivers and facilitation of timely diagnostics and decision-making were not realized. IT is an enabler of innovation in healthcare, but it must be integrated into work processes with a viable business model to realize potential benefits and sustain it. 

  • 2.
    Adams, Mary
    et al.
    King’s College London, UK.
    Maben, Jill
    King’s College London, UK.
    Robert, Glenn
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). King’s College London, UK.
    ‘It’s sometimes hard to tell what patients are playing at’: How healthcare professionals make sense of why patients and families complain about care2018Inngår i: Health, ISSN 1363-4593, E-ISSN 1461-7196, Vol. 22, nr 6, s. 603-623Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    This article draws from sociological and socio-legal studies of dispute between patients and doctors to examine how healthcare professionals made sense of patients’ complaints about healthcare. We analyse 41 discursive interviews with professional healthcare staff working in eight different English National Health Service settings to explore how they made sense of events of complaint and of patients’ (including families’) motives for complaining. We find that for our interviewees, events of patients’ complaining about care were perceived as a breach in fundamental relationships involving patients’ trust or patients’ recognition of their work efforts. We find that interviewees rationalised patients’ motives for complaining in ways that marginalised the content of their concerns. Complaints were most often discussed as coming from patients who were inexpert, distressed or advantage-seeking; accordingly, care professionals hearing their concerns about care positioned themselves as informed decision-makers, empathic listeners or service gate-keepers. We find differences in our interviewees’ rationalisation of patients’ complaining about care to be related to local service contingences rather than to fixed professional differences. We note that it was rare for interviewees to describe complaints raised by patients as grounds for improving the quality of care. Our findings indicate that recent health policy directives promoting a view of complaints as learning opportunities from critical patient/consumers must account for sociological factors that inform both how the agency of patients is envisaged and how professionalism exercised contemporary healthcare work.

  • 3.
    Ahlström, Gerd
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan.
    Integrating improvement learning into health professional educational curricula2008Inngår i: International Forum on Quality Improvement in Healthcare, France, April 24 2008: International Forum on QI , 2008, s. 1-Konferansepaper (Fagfellevurdert)
    Abstract [en]

    We all need to start where we are and also wanting to go further all the time. This is the essence in quality improvement. The leader and the teachers must own this attitude themselves in order to have the ability to be trustworthy for the students. There is evidence in the literature about the impact of education on the professional attitude and role. This means that it is important to work with better professional development for better outcomes in the faculty.

    One starting point for us in the planning of our different programs are that improvement knowledge will be a streak through the whole education in order to establish a professional attitude of daily inspiration to produce the best practise. We have applied all curricula to Boologna declaration and in this system progression in learning is a key point. We have four levels in the basic education (3-years education which lead to Bachelor degree) where we start to introduce 1) Concepts and models in health improvement. Then let our students make a 2) Personal improvement in their everyday life. Later in the education we teach about 3) Evidence practise and systematic literature reviews. Finally the students are 4) Making health improvements in collaboration with the staff during one clinical education.

    All educational programmes on basic level since 2007 include aim descriptions about quality improvement. The aim of the learning is to have the competence to initiate and participate in work about health care improvements.

    Finally, besides the mentions aspects in improvement education there are some other factors that needs for better system performance.

  • 4.
    Aidemark, Jan
    et al.
    Linnaeus University.
    Askenäs, Linda
    Linnaeus University.
    Nygårdh, Annette
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare.
    Strömberg, Anna
    Linköping University.
    User involvement in the co-design of self-care support systems for heart failure patients2015Inngår i: Procedia Computer Science, ISSN 1877-0509, E-ISSN 1877-0509, Vol. 64, s. 118-124Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    In this paper the nature of user involvement in a co-design process will be explored. The outlines of a research project aiming at developing support systems for self-care inpatients suffering from chronic heart failure will be presented. The project is planned to perform a co-design effort where users (patients and healthcare professionals) will be given the opportunity to influence the development of support systems. We will discuss a number of possibilities and challenges that lie in the design of this kind of project and also some findings from its early stages. This report presents the experiences of users’ input, which are discussed in the context of previous research on benefits of user contributions in systems development.

  • 5.
    Alexanderson, Kristina
    et al.
    Karolinska Institutet, Försäkringsmedicin.
    von Knorring, Mia
    Karolinska Institutet, Försäkringsmedicin.
    Keller, Christina
    Högskolan i Jönköping, Internationella Handelshögskolan, IHH, Informatik.
    Impact of a nationwide government program in Sweden on how healthcare managers, in their organisations, manage the work with sickness certification of patients2014Inngår i: The European journal of public health, Vol. 24, Supplement 2, 2014, s. 90-Konferansepaper (Fagfellevurdert)
  • 6.
    Algurén, Beatrix
    et al.
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. University of Gothenburg, Faculty of Education, Department of Food and Nutrition, and Sport Science, Sweden.
    Andersson Gäre, Boel
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Högskolan i Jönköping, Hälsohögskolan, HHJ. ARN-J (Aging Research Network - Jönköping). Region Jönköping County, Futurum, Sweden.
    Thor, Johan
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare.
    Andersson, Ann-Christine
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare.
    Quality indicators and their regular use in clinical practice – results from a survey among users of two cardiovascular National Registries in Sweden2018Inngår i: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 30, nr 10, s. 786-792Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To examine the regular use of quality indicators from Swedish cardiovascular National Quality Registries (NQRs) by clinical staff; particularly differences in use between the two NQRs and between nurses and physicians.

    Design: Cross-sectional online survey study.

    Setting: Two Swedish cardiovascular NQRs: a) Swedish Heart Failure Registry and b) Swedeheart.

    Participants: Clinicians (n=185; 70% nurses, 26% physicians) via the NQRs’ email networks.

    Main outcome measures: Frequency of NQR use for a) producing healthcare activity statistics; b) comparing results between similar departments; c) sharing results with colleagues; d) identifying areas for quality improvement (QI); e) surveilling the impact of QI efforts; f) monitoring effects of implementation of new treatment methods; g) doing research; h) educating and informing healthcare professionals and patients.

    Results: Median use of NQRs was ten times a year (25th and 75th percentiles range: 3 – 23 times/year). Quality indicators from the NQRs were used mainly for producing healthcare activity statistics. Median use of Swedeheart was six times greater than SwedeHF (p<0.000). Physicians used the NQRs more than twice as often as nurses (18 vs. 7.5 times/year; p<0.000) and perceived NQR work more often as meaningful. Around twice as many Swedeheart users had the role to participate in data analysis and in QI efforts compared to SwedeHF users.

    Conclusions: Most respondents used quality indicators from the two cardiovascular NQRs infrequently (< 3 times/year). The results indicate that linking registration of quality indicators to using them for QI activities increases their routine use and makes them meaningful tools for professionals.

    Fulltekst tilgjengelig fra 2019-05-01 00:00
  • 7.
    Andersson, Ann-Christine
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad.
    How to reach effective health service delivery?2017Inngår i: Journal of General Practice, ISSN 2329-9126, Vol. 5, nr 4, artikkel-id 1000320Artikkel i tidsskrift (Fagfellevurdert)
  • 8.
    Andersson, Ann-Christine
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Kvalitetsarbete inom omvårdnad – förbättringskunskap och ständiga förbättringar2018Inngår i: Kvalitetsutveckling inom omvårdnad: sjuksköterskans professionella ansvar / [ed] A. Hommel & Å. Andersson, Lund: Studentlitteratur AB, 2018, s. 45-68Kapittel i bok, del av antologi (Annet vitenskapelig)
  • 9.
    Andersson, Ann-Christine
    et al.
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare.
    Ainalem, Ingrid
    Centre for Innovation and Improvement (CII), Region Skåne, Malmö, Sweden.
    Berg, Agneta
    School of Health and Society, Kristianstad University, Sweden.
    Janlov, Ann-Christin
    School of Health and Society, Kristianstad University, Sweden.
    Challenges to improve inter-professional care and service collaboration for people living with psychiatric disabilities in ordinary housing2016Inngår i: Quality Management in Health Care, ISSN 1063-8628, E-ISSN 1550-5154, Vol. 25, nr 1, s. 44-52Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The aim of this study was to describe health care- and social service professionals' experiences of a quality-improvement program implemented in the south of Sweden. The focus of the program was to develop inter-professional collaboration to improve care and service to people with psychiatric disabilities in ordinary housing. Focus group interviews and a thematic analysis were used. The result was captured as themes along steps in process. (I) Entering the quality-improvement program: Lack of information about the program, The challenge of getting started, and Approaching the resources reluctantly. (II) Doing the practice-based improvement work: Facing unprepared workplaces, and Doing twice the work. (III) Looking backevaluation over 1 year: Balancing theoretical knowledge with practical training, and Considering profound knowledge as an integral part of work. The improvement process in clinical practice was found to be both time and energy consuming, yet worth the effort. The findings also indicate that collaboration across organizational boundaries was broadened, and the care and service delivery were improved.

  • 10.
    Andersson, Ann-Christine
    et al.
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare.
    Andersson Gäre, Boel
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Högskolan i Jönköping, Hälsohögskolan, HHJ. ARN-J (Aging Research Network - Jönköping).
    Thor, Johan
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Lenrick, Raymond
    Rapport om utvärdering av IVO:s lärande tillsyn2018Rapport (Annet vitenskapelig)
    Abstract [sv]

    Inspektionen för vård och omsorg (IVO) har i sin tillsynspolicy lagt fokus på att främja lärande för att stödja utvecklingen av god kvalitet och säkerhet i vård och omsorg. Under 2017 har IVO givit Jönköping Academy for Improvement of Health and Welfare vid Jönköping University i uppdrag att utvärdera tillämpning av lärande tillsyn. Syftet med denna studie var att belysa om, och om möjligt hur, IVO:s tillsyn kan stödja verksamhetsutveckling och förbättring i de tillsynade verksamheter. Det finns många teoribildningar kring lärande och kvalitetsutveckling. Denna rapport tar utgångspunkt i teorier om organisatoriskt lärande, samskapande och förbättringskunskap och belyser vad som kan bidra, och i så fall hur, till en ömsesidig tillit som leder till ett fördjupat lärande som grund för förbättring.

    Studien omfattar två tillsyner, där deltagarna bestod av personal från de berörda verksamheterna, samt IVO-inspektörer från de regionala IVO avdelningar. Det empiriska materialet samlades in genom intervjuer och en observation. En dokumentgenomgång av relevanta IVO dokument skapade underlag för utvecklandet av studiens intervjuguider. Intervjuerna bandades, transkriberades och analyserades med en metod inspirerad av tematisk analys, som utmynnade i fem teman: (I) Förberedelse inför tillsyn; (II) Genomförande i verksamheten; (III) Resultat i verksamheten; (IV) Förutsättningar för lärande; och (V) Önskemål för ökat lärande. Samtliga teman innehåller både förhållanden som stödjer (främjar) och som försvårar (hindrar) lärande:

    • Förberedelsearbetet ansågs inte bidra till en ökad tillit som förutsättning för lärande. Det uttrycktes en önskan om mer samskapande i förberedelsearbetet redan innan tillsynstillfället
    • Det framkom önskemål om att lärandet, som ett av målen med tillsynen, skulle lyftas tydligare i dialogen vid tillsynstillfället.
    • Det uppfattades som svårt att peka på reella resultat i verksamheterna som direkt berodde på tillsynen, men det beskrevs ändå som viktigt att tillsynen fanns.
    • Det fanns olika uppfattningar om hur IVO:s roll som tillsynsmyndighet påverkade lärandet. Ett större fokus på gemensam uppföljning skulle vara ett sätt att optimera lärandet både i verksamheterna och hos IVO:s inspektörer.
    • Ett lärande skulle gynnas av en tydlig gemensam problembeskrivning, samt fortlöpande uppföljningar och delad kunskap, exempelvis genom goda exempel och dialogkonferenser.

    Generellt fanns en stor samstämmighet mellan IVO:s inspektörer och de verksamhetsföreträdare som intervjuats, men vissa skillnader framkom också. Rapporten avslutas med några avslutande reflektioner.

  • 11.
    Andersson, Ann-Christine
    et al.
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare.
    Andersson-Gäre, Boel
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Golsäter, Marie
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. CHILD.
    Melke, Anna
    Erfarenheter från lärandeseminarier: Barn som anhöriga: Reflektioner från följeforskning2016Rapport (Annet vitenskapelig)
    Abstract [sv]

    Under 2015 genomfördes nationella lärandeseminarier för att stärka implementeringen av den lag som ger barn rätt till information, råd och stöd när en förälder plötsligt avlider, är svårt sjuk eller skadad (HSL 2g §). Satsningen var ett förbättringsarbete som omfattade sex landsting som med hjälp av en projektledning träffades vid fyra tillfällen från januari till september. Två av träffarna skedde i Stockholm och två var digitala. Under våren 2015 knöts följeforskning till arbetet med frågeställningar om vilka resultat förbättringsarbetet gav och hur deltagarna upplevde arbetssättet. Syftet var att lyfta fram vad satsningen gav samt att lära inför framtida satsningar – är lärandeseminarier ett användbart arbetssätt för nationella implementeringssatsningar?

    Rapporten visar att lärandeseminarier tycks vara en användbar form. Teamen kan redovisa att de uppnått många av de mål som de föresatte sig under projekttiden. Det handlade om kartläggning av kunskapsläge och strukturer, kompetensutveckling samt utveckling av rutiner och material. Teamen uppskattade också att få delta i ett nationellt sammanhang som gav inspiration. Samtidigt framkom det önskemål om fortsatt och ännu mer handfast stöd i fortsatt implementering i klinisk verksamhet.

  • 12.
    Andersson, Ann-Christine
    et al.
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare.
    Golsäter, Marie
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. CHILD.
    Andersson-Gäre, Boel
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Högskolan i Jönköping, Hälsohögskolan, HHJ. ARN-J (Aging Research Network - Jönköping).
    Melke, Anna
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. The Göteborg Region Association of Local Authorities, Gothenburg, Sweden.
    Learning through networking in healthcare and welfare: The use of a breakthrough collaborative in the Swedish context2017Inngår i: International Journal of Healthcare Management, ISSN 2047-9700, E-ISSN 2047-9719Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Breakthrough Collaborative (BC) aims at learning through networking, mainly at micro level, and is used as a tool to improve care and welfare organizations. The aim of this study was to explore and illuminate the challenges when applying BC model at meso and macro level. In 2010, the Swedish Health and Medical Services Act stated the responsibility of healthcare professionals to consider children’s needs as relatives. This study uses an interactive collaborative research model. To support healthcare organizations in the implementation of the regulation, county councils/regions in Sweden were invited to take part in a BC during 2015. Six teams from different county councils/regions participated. Team members were interviewed several times during the project time. Data were analyzed with an explorative and descriptive qualitative content analysis. The result illuminates the challenges faced when applying BC at meso and macro level. Most challenges concern preparation, support structures and system connections. There are similarities with the challenges met at micro level when BC is used at meso and macro level. But it seems even more important to consider how the team is constituted at meso and macro level to make use of the learnings and achieve long-term impact in the home organization.

  • 13.
    Andersson, Ann-Christine
    et al.
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Futurum-Academy for Health and Care Region Jönköping County, Jönköping, Sweden.
    Melke, Anna
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Göteborg Region Association of Local Authorities, Gothenburg, Sweden.
    Andersson Gäre, Boel
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Högskolan i Jönköping, Hälsohögskolan, HHJ. ARN-J (Aging Research Network - Jönköping).
    Golsäter, Marie
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. CHILD. Futurum-Academy for Health and Care Region Jönköping County, Jönköping, Sweden.
    Identification of children as relatives with a systematic approach; a prerequisite in order to offer advice and support2018Inngår i: Quality Management in Health Care, ISSN 1063-8628, E-ISSN 1550-5154, Vol. 27, nr 3, s. 172-177Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The purpose of this study was to elucidate conditions at all system levels in a specific health care service to develop practices for identification of children as relatives. An interactive research approach with the intention to create mutual learning between practice and research was used. The participating health care service cared for both clinic in- and outpatients with psychiatric disorders. Health care professionals from different system levels (micro, meso, macro) participated, representing different professions. At the first project meeting, it was obvious that there was no systematic approach to identify children as relatives. At the micro level, activities such as a pilot survey and an open house activity were carried out. At the meso level, it was discussed how to better support collaboration between units. At the management (macro) level, it was decided that all units should appoint at least one child agent, with the aim to increase collaboration throughout the whole health care service. To change focus, in this case from only parents to inclusion of children, is an important challenge faced by health care services when forced to incorporate new policies and regulations. The new regulations contribute to increased complexity in already complex organizations. This study highlights that such challenges are underestimated.

  • 14.
    Andersson Bäck, Monica
    et al.
    University of Gothenburg.
    Kjellström, Sofia
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Högskolan i Jönköping, Hälsohögskolan, HHJ, Institutet för gerontologi. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Avby, Gunilla
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare.
    Identity work of successful primary care managers and competing institutional logics2017Konferansepaper (Fagfellevurdert)
  • 15.
    Andersson Bäck, Monica
    et al.
    University of Gothenburg.
    Kjellström, Sofia
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Högskolan i Jönköping, Hälsohögskolan, HHJ, Institutet för gerontologi. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Avby, Gunilla
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare.
    Medical manager hybrids for handling institutional complexity and change in primary care2017Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Introduction: This article deals with hybrid persons combining medical professionalism and management for handling institutional complexity and change in primary care. Primary care and identity are in transition in many western countries, in Sweden emphasized by the 2007 reform for patient choice and competition. Research has shown that embedded hybrid actors, familiar and socialized in a field and to its logics, tend to be influential for handling complexity and change. Yet hydrids and their enactment in primary care is an underexplored area.

    Aim: The aim is to contribute to our understanding of hybrid persons and how they are combining medical professionalism and management in primary care, while managing complexity and change.

    Material and methods: In a case study of six successful primary healthcare centers, public and private, covering 56 interviews and observations with various professions, two medical managers ‘hybrids’ showed to be particularly interesting. These were analyzed in-depth, including analysis of staff’s and colleagues’ experiences and contrasted by other managers and hybrids. For the analysis we draw on institutional logic perspective (Thornton, Occasion & Lounsbury 2012) in order to capture preconditions as well as enactment of such change agents.

    Results/conclusions: The hydrids contributed to innovation, creativity and learning in their primary care centres. At their workplace, coherence and a good ambience coexisted with feelings of high work pace and lacking role clarity among the multidisciplinary staff. Categorized in line with McGivern and colleagues(2015) term as ‘willing hybrids’, the persons studied revealed high ambitions to challenge existing institutional order giving professionalism new forms, while seeking to innovate practices and division of work among healthcare staff in primary care. By doing so the hybrids integrated professionalism and managerialism and were influential in reframing problems and solutions, which aligned several logics at play. However several obstacles related to professional as well as bureaucratic issues appeared along the way.

  • 16.
    Areskoug Josefsson, Kristina
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Value of performing a Rasch analysis on a reliable and valid instrument – case study of the SA-SH2019Inngår i: Artikkel i tidsskrift (Fagfellevurdert)
  • 17.
    Areskoug Josefsson, Kristina
    et al.
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Avby, Gunilla
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Andersson Bäck, Monica
    Department of Social Work, University of Gothenburg, Gothenburg, Sweden.
    Kjellström, Sofia
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Workers’ experiences of healthy work environment indicators at well-functioning primary care units in Sweden: a qualitative study2018Inngår i: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 36, nr 4, s. 406-414Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: Staff experiences of healthy work environment (HWE) indicators at primary care units can assist in understanding why some primary care units function better than others. The aim of the study was to create increased understanding of how workers experienced HWE indicators at well-functioning primary care units.

    Design: Fifty in-depth interviews with staff at six primary care units in Sweden were analysed with deductive content analysis, revisiting a systematic review of HWE indicators.

    Results: The study presents additional perspectives on staff experiences of HWE indicators at well-functioning primary care units. The included primary care units (PCU) shared a similar pattern of work environment indicators, with unique solutions and strategies to meet shared challenges. Staff at the included PCUs were encouraged to work to create and sustain a HWE, but each domain (indicator) also provided challenges that the staff and organisation needed to meet. The results suggest that useful approaches for a healthy work environment could be to address issues of organisational virtuousness, employee commitment and joy at work.

    Conclusions: Both managers and staff are encouraged to actively work not only to create and sustain an HWE but also to promote organisational virtuousness, employee commitment, joy at work and to increase the performance at work, which is of benefit to staff, patients and society.

    Key Points

    • Staff at well-functioning primary care units (PCUs) experienced healthy work environments
    • The included PCUs shared a similar pattern of work environment indicators, with unique solutions and strategies to meet shared challenges.
    • Staff at the included PCUs were encouraged to work to create and sustain a healthy work environment, but each domain (indicator) also provided challenges that the staff and organisation needed to meet.
    • The results suggest that useful approaches for a healthy work environment could be to address issues of organisational virtuousness, employee commitment and joy at work.
  • 18.
    Aronsson, Frida
    et al.
    Högskolan i Jönköping, Hälsohögskolan, HHJ. Kvalitetsförbättring och ledarskap inom hälsa och välfärd.
    Johansson, Sofia
    Högskolan i Jönköping, Hälsohögskolan, HHJ. Kvalitetsförbättring och ledarskap inom hälsa och välfärd.
    Organisatoriskt lärande för att öka vårdkvalitet: Lärdomar av att utveckla processledning vid en operations- och intensivvårdsklinik2018Independent thesis Advanced level (degree of Master (Two Years)), 80 poäng / 120 hpOppgave
    Abstract [sv]

    Bakgrund: Komplexa verksamheter måste fokusera på processerna, ett organisatoriskt helhetsperspektiv och lärande samt ha patienten i centrum för att säkra vårdkvaliteten. På Operations- och intensivvårdskliniken, Ryhov, har processarbete påbörjats men utvecklingspotential finns samt utrymme för tydligare rutiner gällande patientdelaktighet.

     

    Syfte: Förbättringsarbetets syfte var att identifiera och minska kvalitetsgap i verksamheten som påverkar patienten, genom att utveckla klinikens processledning och det organisatoriska lärandet. Studiens syfte var att beskriva medarbetarens uppfattning om processledningens koppling till vårdkvalitet, samt beskriva deras erfarenheter från processledningsutvecklingsarbetet.

     

    Metod: Förbättringsarbetet har i projektgruppsformat och med Nolans förbättringsmodell utvecklat det organisatoriska lärandet kring två pilotprocesser. Studien av förbättringsarbetet är kvalitativ och baseras på sex fokusgruppsintervjuer. Intervjumaterialet analyserades med hjälp av kvalitativ innehållsanalys med induktiv ansats.

     

    Resultat: Processledning kräver tillgång till förbättrings- och yrkeskompetens. Organisationen måste ge förutsättningar för en varaktighet där nyttan är tydlig och resurser är tillräckliga. Vårdkvaliteten ökar när organisationen arbetar strukturerat, personcentrerat och med patientsäkerhet som fokus.

     

    Slutsatser: Processledning kan ge organisationen förutsättningar att skapa kontinuerlig förbättring med fokus på organisatoriskt lärande och ökad vårdkvalitet för patienten. Organisationen måste arbeta aktivt för att göra detta till en integrerad och levande del av verksamheten.

  • 19.
    Avby, Gunilla
    et al.
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare.
    Kjellström, Sofia
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Högskolan i Jönköping, Hälsohögskolan, HHJ, Institutet för gerontologi. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Andersson Bäck, Monica
    University of Gothenburg.
    A reform as a lever for innovation and professionalism?2017Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Introduction: Consistently with international trends, managerial reforms and incentive systems in Sweden have been introduced to achieve quality improvement and increased efficiency in welfare services. Evidence suggests that targeted financial micro-incentives can stimulate change in certain areas of care, but they do not result in more radical change, such as service transformations or innovation.

    Aim: In this study we explore how organizational performance are changing within the context of a patient choice reform in primary healthcare.

    Material and Methods: This qualitative study is based on 48 semi-structured interviews with various professions (managers, physicians, nurses, physical- and occupational therapists, care administrators, and nurse assistants) at five PHCCs, conducted as part of a study designed to explore financial incentives and motivation in PHC in Sweden. The PHCCs were purposively selected to ensure the inclusion of both public and private facilities. All centers had a longstanding reputation for good leadership and high quality care. 

    Results: The findings show how professional fields and traits were dissolving and changing, triggering the emergence of innovative solutions in practice. Through ongoing negotiations of professional boundaries new practices unfolded and professionalism increasingly was achieved through contextual conditions. The expanding and changing of professional boundaries as shown in the study are implied to stimulate innovative processes. Thus, the main findings suggest that innovative practices developed as a relationship between contextual conditions and professionalism. E.g. nurses and physical therapists remitted patients directly to the hospital, multiprofessional teams for patient groups with joint needs handled patients that previous needed hospital care, and nurse assistants became responsible for summing patients with minor hypertension for blood pressure controls and consultations.

    Conclusions: The reform seemed to act as a lever for innovation and professionalism under certain conditions. How work is organized and managed is a contextual factor that not only affects work circumstances, but also provides conditions for innovation and professionalism. Impartial to governments’ ambitions to improve their responsiveness to the needs of citizens by altering market rules, new provider models may be of little assistance in achieving the desired effect on health sector reform outcomes if suitable contextual conditions are missing.

  • 20.
    Avby, Gunilla
    et al.
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Kjellström, Sofia
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Andersson Bäck, Monica
    Department of Social Work, University of Gothenburg, Göteborg, Sweden.
    Tending to innovate in Swedish primary health care: a qualitative study2019Inngår i: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 19, nr 1, artikkel-id 42Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Policymakers in many countries are involved in system reforms that aim to strengthen the primary care sector. Sweden is no exception. Evidence suggests that targeted financial micro-incentives can stimulate change in certain areas of care, but they do not result in more radical change, such as innovation. The study was performed in relation to the introduction of a national health care reform, and conducted in Jönköping County Council, as the region's handling of health care reforms has attracted significant national and international interest. This study employed success case method to explore what enables primary care innovations.

    METHODS: Five Primary Health Care Centres (PHCCs) were purposively selected to ensure inclusion of a variety of aspects, such as size, location, ownership and regional success criteria. 48 in-depth interviews with managers and staff at the recruited PHCCs were analysed using content analyses. The COREQ checklist for qualitative studies was used to assure quality standards.

    RESULTS: This study identified three types of innovations, which break with previous ways of organizing work at these PHCCs: (1) service innovation; (2) process innovation; and (3) organizational innovation. A learning-oriented culture and climate, comprising entrepreneurial leadership, cross-boundary collaboration, visible and understandable performance measurements and ability to adapt to external pressure were shown to be advantageous for innovativeness.

    CONCLUSIONS: This qualitative study highlights critical features in practice that support primary care innovation. Managers need to consistently transform and integrate a policy "push" with professionals' understanding and values to better support primary care innovation. Ultimately, the key to innovation is the professionals' engagement in the work, that is, their willingness, capability and opportunity to innovate.

  • 21.
    Avby, Gunilla
    et al.
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare.
    Kjellström, Sofia
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Högskolan i Jönköping, Hälsohögskolan, HHJ, Institutet för gerontologi. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Andersson Bäck, Monica
    University of Gothenburg.
    Transforming primary healthcare: Exploring a new provider model as a lever for innovation and professionalism2017Konferansepaper (Fagfellevurdert)
  • 22.
    Avby, Gunilla
    et al.
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Kjellström, Sofia
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Andersson Bäck, Monica
    Göteborgs universitet.
    Areskoug Josefsson, Kristina
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Andersson-Gäre, Boel
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Högskolan i Jönköping, Hälsohögskolan, HHJ. ARN-J (Aging Research Network - Jönköping).
    Sparf, Anette
    Siljehult, Mats
    Samarbete bygger en stark primärvård2017Inngår i: Dagens Nyheter 2017-08-17, ISSN 1101-2447Artikkel i tidsskrift (Annet (populærvitenskap, debatt, mm))
  • 23.
    Azong, Jecynta Amboh
    et al.
    University of Stirling, UK.
    Wilinska, Monika
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för beteendevetenskap och socialt arbete. Högskolan i Jönköping, Hälsohögskolan, HHJ. ARN-J (Aging Research Network - Jönköping). University of Stirling, UK.
    Into a footnote: Unpaid care work and the Equality Budget in Scotland2017Inngår i: The European Journal of Women's Studies, ISSN 1350-5068, E-ISSN 1461-7420, Vol. 24, nr 3, s. 218-232Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    This article analyses the visibility of unpaid care work in Scotland by examining the (non-)development of discourse on unpaid care work in economic policy documents. Drawing on the problem approach to policy analysis, the article engages with the Equality Budget Statements (EBS) as policy documents that not only inform the government’s spending plans but are foremost statements of values and norms pursued by the government. This critical reading reveals that certain discourses give different meanings to women’s lives through the political significance of what remains unproblematized as part of the ensuing care discourse in Scotland. The developing discourse on economic policy and equality suggests that equality in Scotland is presupposed on labour market participation. This shrinks discourse on unpaid care work; the problem of unpaid care work is silenced, while the problem of women’s access to employment is redefined to mean a problem of difference and costly childcare only. The way certain issues have or have not appeared in governmental documents is explanatory of the importance and relevance of unpaid care work to the political discourse.

  • 24.
    Bartholdson, Pamela
    Högskolan i Jönköping, Hälsohögskolan, HHJ. Kvalitetsförbättring och ledarskap inom hälsa och välfärd.
    Så förhindrar vi fallolyckor - Observationsstudie av en multifaktoriell intervention2013Independent thesis Advanced level (degree of Master (Two Years)), 20 poäng / 30 hpOppgave
  • 25.
    Batalden, Maren
    et al.
    Department of Medicine, Cambridge Health Alliance, Cambridge, MA, United States.
    Batalden, Paul B.
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth, Lebanon, NH, United States.
    Margolis, Peter
    Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
    Seid, Michael
    Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
    Armstrong, Gail
    College of Nursing, University of Colorado, Aurora, CO, United States.
    Opipari-Arrigan, Lisa
    Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
    Hartung, Hans
    Department of Pulmonary Medicine, University Hospital Crosshouse, Kilmarnock, East Ayrshire, United Kingdom.
    Coproduction of healthcare service2016Inngår i: BMJ Quality and Safety, ISSN 2044-5415, E-ISSN 2044-5423, Vol. 25, nr 7, s. 509-517Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Efforts to ensure effective participation of patients in healthcare are called by many names - patient centredness, patient engagement, patient experience. Improvement initiatives in this domain often resemble the efforts of manufacturers to engage consumers in designing and marketing products. Services, however, are fundamentally different than products; unlike goods, services are always 'coproduced'. Failure to recognise this unique character of a service and its implications may limit our success in partnering with patients to improve health care. We trace a partial history of the coproduction concept, present a model of healthcare service coproduction and explore its application as a design principle in three healthcare service delivery innovations. We use the principle to examine the roles, relationships and aims of this interdependent work. We explore the principle's implications and challenges for health professional development, for service delivery system design and for understanding and measuring benefit in healthcare services.

  • 26.
    Beckerman, Carina
    Handelshögskolan i Stockholm.
    Historien om en datajournal2005Rapport (Annet vitenskapelig)
    Abstract [sv]

    “Berätta för mig om datajournalprojektet? ”Med den uppmaningen i huvudet gick jag till mitt första möte med fyra anställda på en medicinsk avdelning på X-sjukhuset som ett år tidigare implementerat en datorbaserad patientjournal. Patientjournaler tillhör ju, liksom exempelvis flygledarjournaler, en viss sorts intellektuella artefakter som tills nyligen skrevs för hand med penna på papper. Den kunskap som ligger bakom produktionen av dessa föremål lärs ofta in på plats från en överordnad genom upprepad handling. När arbetsverktyg som dessa datorbaseras sker det inte smärtfritt. Både arbetsrutiner och arbetsrelationer förändras liksom även innehållet i dokumentet. Eftersom jag dessutom ville skaffa erfarenhet av narrativ metod så beslöt jag att låta fyra anställda och projektledaren på kliniken berätta så fritt som möjligt utan inblandning från min sida; därav ovanstående enkla uppmaning. Varför narrativ metod, undrar möjligen en del. Det är inte en vanlig metod inom forskning om informationssystem. Nej, men personligen tror jag och många andra med mig att historier spelar en ofta bortglömd roll i olika organisationers försök att utveckla, implementera och använda informationsteknologi. Detta, och den amerikanske sociologen Elliot Mishlers kritik om att ett alltför strukturerat sätt att intervjua förvandlar människor till artificiella objekt samtidigt som viktiga aspekter i exempelvis förändringsprocesser går förlorade, gjorde mig intresserad av att pröva narrativ metod. Dessutom är patientjournalen i sig en berättelse om en patients sjukdom. Många människor på olika arbetsplatser genomgår numera också dessa så flitigt förekommande IT-projekt, en del lyckade och andra mindre lyckade. En målgrupp för denna studie är därför personer som på olika sätt deltar i och arbetar med implementering av ny informationsteknologi inom sjukvården. En annan målgrupp är kollegor intresserade av narrativ metod.

  • 27.
    Beckerman, Carina
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för beteendevetenskap och socialt arbete. Högskolan i Jönköping, Hälsohögskolan, HHJ. Kvalitetsförbättringar, innovationer och ledarskap inom vård och socialt arbete.
    Implications of Transforming the Patient Record into a Knowledge Management System: Initiating a Movement of Coordination and Enhancement2008Inngår i: The ICFAI University Journal of Knowledge Management, ISSN 0972-9216, Vol. Nov, nr 6Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Today there is often a need to re-innovate who you are and what you do and re-think the tools that are used and the business models that guide action. The purpose of this paper is to show how transforming a document, such as a patient record, might start a horizontal and vertical movement, a movement of coordination and enhancement in an organizational setting, such as a hospital clinic. The observations presented here and the conclusions drawn were obtained during a three year case study following implications of constructing and computerizing a patient record at three different hospitals. The results were then analyzed, interpreted and discussed within a framework combining theories about knowledge management and with cognitive theories about use of interpretative schemes and representations. This paper tries to look beyond the implications of reconstructing a patient record on a micro-level or explore if it is good or bad to computerize it. Instead this paper theorizes about how re-thinking the interpretative scheme for what a patient record is and how it may be used might restructure a health care setting. It proposes that what the employees want to achieve with the knowledge management system depends on what strategy they have for it.

  • 28.
    Beckerman, Carina
    Handelshögskolan i Stockholm.
    Sjukhus eller sjukvård - design av betong och infrastruktur2008Inngår i: Detta borde vårddebatten handla om / [ed] Claes-Fredrik Helgesson, Hans Winberg, Stockholm: IFL/EFI , 2008, s. 61-77Kapittel i bok, del av antologi (Annet (populærvitenskap, debatt, mm))
  • 29.
    Beckerman, Carina
    Högskolan i Jönköping, Hälsohögskolan, HHJ. Kvalitetsförbättringar, innovationer och ledarskap inom vård och socialt arbete. Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för beteendevetenskap och socialt arbete.
    Transforming and Computerizing Professional Artifacts: An Underestimated Opportunity for Learning2010Inngår i: International Journal of Healthcare Delivery Reform Initiative, ISSN 1938-0216, Vol. 2, nr 3, s. -10Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Improving the artifacts a knowledge worker uses and how he or she exercises his or her knowledge is a desire that is part of being professional, especially since modern man are supposed to live in a knowledge society. In the knowledge society there is a continuous structuring and re-structuring, construction and re-construction and learning and re-learning going on due to implementing new information and communication technology. But many of these projects fail in spite of management spending huge amounts of money on them. This paper focuses on and wants to create an awareness of how an artefact such as a new knowledge management system becomes a driving force behind expanding the knowledge of an anesthesist and has implications for continuous learning among a group of employees at the anesthesia and intensive care unit. In addition to this, implementing new technology is an underestimated opportunity for learning. This paper suggests that a significant educational effort is taking place in society channelled through many these IT-projects, even when they fail.

  • 30.
    Bergerum, Carolina
    Högskolan i Jönköping, Hälsohögskolan, HHJ. Kvalitetsförbättring och ledarskap inom hälsa och välfärd.
    Quality Improvement in a Maternity Ward and Neonatal Intensive Care Unit. What are staff and patients' experiences of Experience-based Co-design?: Part 1: A qualitative study2012Independent thesis Advanced level (degree of Master (Two Years)), 20 poäng / 30 hpOppgave
    Abstract [en]

    Background: Recent focus on quality and patient safety has underlined the need to involve patients in improving healthcare. “Experience-based Co-design” (EBCD) is an approach to capture and understand patient and staff (i. e. users) experiences, identifying so called “touch points” and then working together equally in improvement efforts.

    Purpose:This article elucidates patient (defined as the mother-newborn couple with next of kin) and staff experiences following improvement work carried out according to EBCD in a maternity ward and neonatal intensive care unit (NICU) in a small, acute hospital in Sweden.

    Method: An experience questionnaire, derived from the EBCD approach tool set, was used for continuously evaluating each event of the EBCD improvement project. Furthermore, a focus group interview with staff and in-depth interviews with mother-father couples were held in order to collect and understand the experiences of working together according to EBCD. The analysis and interpretation of the interview data was carried through using qualitative, problem-driven content analysis. Themes, categories and sub-categories presented in this study constitute the manifest and latent content of the participants’ experiences of Experience-based Co-design.

    Results:The analysis of the experience questionnaires, prior to the interviews, revealed mostly positive experiences of the participation. Both staff and patient participants stated generally happy, involved, safe, good and comfortable experiences following each event of the improvement project so far.

    Two themes emerged during the analysis of the interviews. For staff participants the improvement project was a matter of learning within the microsystem through managing practical issues, moving beyond assumptions of improvement work and gaining a new way of thinking. For patients, taking part of the improvement project was expressed as the experience of involvement in healthcare through their participation and through a sense of improving for the future.

    Discussion: This study confirms that, despite practical obstacles for participants, the EBCD approach to improvement work provided an opportunity for maternity ward /NICU care being explored respectfully at the experience level, by assuring the sincere sharing of useful information within the microsystem continuously, and by encouraging and supporting the equal involvement of both staff and patients. Staff and patients wanted and were able to contribute to the EBCD process of gathering information about their experiences, analyzing and responding to collected data, and engaging themselves in improving the same. Furthermore, the EBCD approach provided staff and patients the opportunity of learning within the microsystem. Nevertheless, the responsibility of the improvement work remained the responsibility of the healthcare professionals.

  • 31.
    Biguet, Gabriele
    et al.
    Karolinska Institutet.
    Ekstrand Sporre, Åsa
    Jönköpings läns landsting.
    Thörne, Karin
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare.
    Att utvecklas genom att reflektera tillsammans i grupp2015Inngår i: Att lära och utvecklas i sin profession / [ed] Gabriele Biguet, Ingrid Lindquist, Cathrin Martin, Anna Pettersson, Lund: Studentlitteratur AB, 2015, s. 123-146Kapittel i bok, del av antologi (Annet vitenskapelig)
  • 32. Blackwell, R. W. N.
    et al.
    Lowton, K.
    Robert, Glenn
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, United Kingdom.
    Grudzen, C.
    Grocott, P.
    Using Experience-based Co-design with older patients, their families and staff to improve palliative care experiences in the Emergency Department: A reflective critique on the process and outcomes2017Inngår i: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 68, s. 83-94Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background

    Increasing use of emergency departments among older patients with palliative needs has led to the development of several service-level interventions intended to improve care quality. There is little evidence of patient and family involvement in developmental processes, and little is known about the experiences of − and preferences for – palliative care delivery in this setting. Participatory action research seeking to enable collaborative working between patients and staff should enhance the impact of local quality improvement work but has not been widely implemented in such a complex setting.

    Objectives

    To critique the feasibility of this methodology as a quality improvement intervention in complex healthcare settings, laying a foundation for future work. Setting an Emergency Department in a large teaching hospital in the United Kingdom.

    Methods

    Experience-based Co-design incorporating: 150 h of nonparticipant observation; semi-structured interviews with 15 staff members about their experiences of palliative care delivery; 5 focus groups with 64 staff members to explore challenges in delivering palliative care; 10 filmed semi-structured interviews with palliative care patients or their family members; a co-design event involving staff, patients and family members.

    Findings

    The study successfully identified quality improvement priorities leading to changes in Emergency Department-palliative care processes. Further outputs were the creation of a patient-family-staff experience training DVD to encourage reflective discussion and the identification and application of generic design principles for improving palliative care in the Emergency Department. There were benefits and challenges associated with using Experience-based Co-design in this setting. Benefits included the flexibility of the approach, the high levels of engagement and responsiveness of patients, families and staff, and the impact of using filmed narrative interviews to enhance the ‘voice’ of seldom heard patients and families. Challenges included high levels of staff turnover during the 19 month project, significant time constraints in the Emergency Department and the ability of older patients and their families to fully participate in the co-design process.

    Conclusion

    Experience-based Co-design is a useful approach for encouraging collaborative working between vulnerable patients, family and staff in complex healthcare environments. The flexibility of the approach allows the specific needs of participants to be accounted for, enabling fuller engagement with those who typically may not be invited to contribute to quality improvement work. Recommendations for future studies in this and similar settings include testing the ‘accelerated' form of the approach and experimenting with alternative ways of increasing involvement of patients/families in the co-design phase. 

  • 33.
    Bonnivier, Anna
    Högskolan i Jönköping, Hälsohögskolan, HHJ. Kvalitetsförbättring och ledarskap inom hälsa och välfärd.
    Då; DiabetespatientNu; En människa med diabeteserfarenhet: Ett förbättringsarbete och en fallstudie om vård på ändrade villkor när en diabetesmottagning införde samskapad vård.2018Independent thesis Advanced level (degree of Master (Two Years)), 20 poäng / 30 hpOppgave
    Abstract [sv]

    Sammanfattning

     

    Bakgrund

    Ett förbättringsutrymme i diabetesvården för personer med förhöjda blodsockernivåer, HbA1c, vilket beskrevs olika utifrån en patient- och medarbetarperspektiv. Förbättringsutrymmet handlade om patientdelaktighet och standardiserade arbetssätt.

    Syfte

    Förbättringsarbete: Att diabetespatienter med förhöjt HbA1c upplevde delaktighet i sin vård och att deras diabetesrelaterade hälsa förbättrades. Mål: sänka medelvärdet för HbA1c> 9%.

    Studie av förbättringsarbete: Studera om och hur införandet av PROM/PREM enkäten bidrog till en samskapad vård utifrån medarbetarnas uppfattning.

    Metod

    Nolans förbättringsmodell

    Fallstudie, kvalitativ innehållsanalys

     

    Resultat:

    Det totala medelvärdet för HbA1c sjönk med 15,2%,

    13 av 14 patienter sänkte sitt HbA1c.

    PROM; två av tre kvalitetsparametrar hade en positiv förskjutning.

    PREM; en av tre kvalitetsparametrar hade en positiv förskjutning.

     

    Resultatet av studien indikerade att medarbetare upplevde en fördjupade vårdrelationen med patienter samt att de uppfattade en balans i kunskapsutbytet mellan deras olika erfarenheter av sjukdomen.

    Diskussion: Resultaten av förbättringsarbete och studie indikerade att samskapad vård skapade förutsättningar till förbättrad diabetesrelaterad hälsa samt upplevd delaktighet. PROM/PREM svaren identifierade områden som möjliggjorde för vårdgivaren att utgå från individens behov vilket stärkte dennes roll i mötet.

    Slutsats: Samskapad vård ger möjligheter till förbättrad diabetesrelaterad hälsa och delaktighet som skapar förutsättningar för kunskapsutbyte och fördjupad vårdrelation mellan patient och vårdgivare.

  • 34.
    Borén, Kristina
    Högskolan i Jönköping, Hälsohögskolan, HHJ. Kvalitetsförbättring och ledarskap inom hälsa och välfärd.
    Co-production design av ett beslutsstöd för patienter med rotatorkuffruptur2016Independent thesis Advanced level (degree of Master (One Year)), 10 poäng / 15 hpOppgave
    Abstract [sv]

    Enligt hälso- och sjukvårdslagen kännetecknas en god vård av att den är individfokuserad, jämlik och säker. Numera finns det en mängd så kallade beslutsstöd som är tillgängliga för patienter inom hälso-och sjukvård i världen. Syftet med dessa är att vara en tillförlitlig källa med hälsoinformation som kan hjälpa patienten att fatta beslut utifrån personliga värderingar. Det saknas dock ett svenskt beslutsstöd som riktar sig till patienter med rotatorkuffruptur. Syftet med denna studie är att vidareutveckla beslutsstödet från USA ”Treatment Options for Rotator Cuff Tears: A Guide for Adults” från 2010 till svenska förhållanden. För att undersöka skillnader och likheter mellan det och svensk behandlingspraxis kring rotatorkuffruptur, samt hur beslutsstödet uppfattas av patienter, så har en co-production design med kvalitativ innehållsanalys med deduktiv ansats använts. Detta innebar översättning av beslutsstödet till svenska, intervjuer med erfarna fysioterapeuter och ortopedläkare som behandlat patienter med rotatorkuffruptur, samt intervjuer med patienter som har haft rotatorkuffruptur och valt behandlingsmetod.

    Studien kom fram till att huvudsakliga likheter mellan beslutsstödet och behandlingspraxis bestod i att patienten har en aktiv roll i behandlingsprocessen, beskrivningen av aktuella behandlingsalternativ och förståelse för skadan. Huvudsakliga skillnader var att läkarens roll var mer framträdande jämfört med fysioterapeutens i beslutsstödet, samt att detaljer kring konservativ och postoperativ behandling saknades. Ortopedläkare och fysioterapeuter beskriver också en avsaknad av ett stödsystem för beslut i dagens kliniska praxis. Patienterna var överlag positiva till beslutsstödet då de upplevde att ett sådant skulle kunna vara ett stöd vid val av behandling, samt att det skulle kunna skapa trygghet. De fann beslutsstödet överlag som enkelt och lättförståeligt med hänsyn till innehåll och layout, samt kunde vara en plattform för dialog med ortopedläkare/fysioterapeut. De sistnämnda var också positiva till beslutsstöd, vilket kan vara en språngbräda för att etablera klinisk konsensus.

    Vidare forskning behövs för att utvärdera effekterna gällande följsamhet till det valda alternativet i beslutsprocessen och vilken detaljnivå som behövs i beslutsstödet. Senaste rön behöver också följas upp för att kunna förbättra innehållet. Det finns också behov av att, med fokus på utfall för patienten, undersöka påverkan på kostnad och effektivitet i vården.

  • 35.
    Burnett, Susan
    et al.
    Imperial College London, UK.
    Mendel, Peter
    Rand Corporation, Santa Monica, CA, USA.
    Nunes, Francisco
    Lisbon University Institute, Portugal.
    Wiig, Siri
    University of Stavanger, Norway.
    van den Bovenkamp, Hester
    Erasmus University Rotterdam, The Netherlands.
    Karltun, Anette
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Tekniska Högskolan, JTH, Industriell organisation och produktion. Högskolan i Jönköping, Tekniska Högskolan, JTH. Forskningsmiljö Industriell produktion.
    Robert, Glenn
    King’s College London, UK.
    Anderson, Janet
    King’s College London, UK.
    Vincent, Charles
    Oxford University, UK.
    Fulop, Naomi
    University College London, UK.
    Using institutional theory to analyse hospital responses to external demands for finance and quality in five European countries2016Inngår i: Journal of Health Services Research and Policy, ISSN 1355-8196, E-ISSN 1758-1060, Vol. 21, nr 2, s. 109-117Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives: Given the impact of the global economic crisis, delivering better health care with limited finance grows more challenging. Through the lens of institutional theory, this paper explores pressures experienced by hospital leaders to improve quality and constrain spending, focusing on how they respond to these often competing demands.

    Methods: An in-depth, multilevel analysis of health care quality policies and practices in five European countries including longitudinal case studies in a purposive sample of ten hospitals.

    Results: How hospitals responded to the financial and quality challenges was dependent upon three factors: the coherence of demands from external institutions; managerial competence to align external demands with an overall quality improvement strategy, and managerial stability. Hospital leaders used diverse strategies and practices to manage conflicting external pressures.

    Conclusions: The development of hospital leaders’ skills in translating external requirements into implementation plans with internal support is a complex, but crucial, task, if quality is to remain a priority during times of austerity. Increasing quality improvement skills within a hospital, developing a culture where quality improvement becomes embedded and linking cost reduction measures to improving care are all required.

  • 36.
    Bäck, Monica Andersson
    et al.
    Department of Social Work, University of Gothenburg, Sweden.
    Calltorp, Johan
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare.
    The Norrtaelje model: a unique model for integrated health and social care in Sweden2015Inngår i: International Journal of Integrated Care, ISSN 1568-4156, E-ISSN 1568-4156, Vol. 15, s. 1-11, artikkel-id e016Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Many countries organise and fund health and social care separately. The Norrtaelje model is a Swedish initiative that transformed the funding and organisation of health and social care in order to better integrate care for older people with complex needs. In Norrtaelje model, this transformation made it possible to bringing the team together, to transfer responsibility to different providers, to use care coordinators, and to develop integrated pathways and plans around transitions in and out of hospital and from nursing homes to hospital. The Norrtaelje model operates in the context of the Swedish commitment to universal coverage and public programmes based on tax-funded resources that are pooled and redistributed to citizens on the basis of need. The experience of Norrtaelje model suggests that one way to promote integration of health and social care is to start with a transformation that aligns these two sectors in terms of high level organisation and funding. This transformation then enables the changes in operations and management that can be translated into changes in care delivery. This "top-down" approach must be in-line with national priorities and policies but ultimately is successful only if the culture, resource allocation and management are changed throughout the local system.

  • 37.
    Börjesson, Ulrika
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för beteendevetenskap och socialt arbete. Högskolan i Jönköping, Hälsohögskolan, HHJ. Kvalitetsförbättring och ledarskap inom hälsa och välfärd. Högskolan i Jönköping, Hälsohögskolan, HHJ. SALVE (Socialt arbete, Livssammanhang, Välfärd).
    From shadow to person: Exploring roles in participant observations in an eldercare context2014Inngår i: Qualitative Social Work, ISSN 1473-3250, E-ISSN 1741-3117, Vol. 13, nr 3, s. 406-420Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    This article explores participant observation as a research method and more specifically addresses the intriguing situation of the researcher's role in interacting with participants in the setting. The materials used in the analysis are field notes from participant observations focused on staff at two eldercare units in a mid-sized city in Sweden. Because limitations when referring to Raymond Gold's roles of participant observations are known but sparsely described and discussed, this text attempts to provide that description and discussion. The specific question posed in the article is, (How) do roles for the researcher in participant observations change during the course of fieldwork? Randall Collins' theory on interaction ritual chains is used as an analytical tool to identify symbols in the two staff groups. The examples chosen from the field are symbols displayed at the units, which moreover illustrate that the researcher’s roles in participant observations not only change once or twice during the course of fieldwork but also change continuously. Consequently, fieldworkers shift roles in different situations when observing a variety of people and settings. Observations are developed in the interaction between the researcher and the participants; therefore, referring observations to a number of roles is restrictive and limiting.

  • 38.
    Börjesson, Ulrika
    et al.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för beteendevetenskap och socialt arbete. Högskolan i Jönköping, Hälsohögskolan, HHJ. Kvalitetsförbättring och ledarskap inom hälsa och välfärd. Högskolan i Jönköping, Hälsohögskolan, HHJ. SALVE (Socialt arbete, Livssammanhang, Välfärd).
    Bengtsson, Staffan
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för beteendevetenskap och socialt arbete. Högskolan i Jönköping, Hälsohögskolan, HHJ. SALVE (Socialt arbete, Livssammanhang, Välfärd).
    Cedersund, Elisabet
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för beteendevetenskap och socialt arbete. Högskolan i Jönköping, Hälsohögskolan, HHJ. SALVE (Socialt arbete, Livssammanhang, Välfärd).
    “You have to have a certain feeling for this”: Exploring tacit knowledge in elder careManuskript (preprint) (Annet vitenskapelig)
  • 39.
    Börjesson, Ulrika
    et al.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för beteendevetenskap och socialt arbete. Högskolan i Jönköping, Hälsohögskolan, HHJ. Kvalitetsförbättring och ledarskap inom hälsa och välfärd. Högskolan i Jönköping, Hälsohögskolan, HHJ. SALVE (Socialt arbete, Livssammanhang, Välfärd).
    Bengtsson, Staffan
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för beteendevetenskap och socialt arbete. Högskolan i Jönköping, Hälsohögskolan, HHJ. SALVE (Socialt arbete, Livssammanhang, Välfärd).
    Henning, Cecilia
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för beteendevetenskap och socialt arbete. Högskolan i Jönköping, Hälsohögskolan, HHJ. SALVE (Socialt arbete, Livssammanhang, Välfärd).
    A Free regulated work?: Organizational culture and shared knowledge in elder careManuskript (preprint) (Annet vitenskapelig)
  • 40.
    Börjesson, Ulrika
    et al.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för beteendevetenskap och socialt arbete. Högskolan i Jönköping, Hälsohögskolan, HHJ. Kvalitetsförbättring och ledarskap inom hälsa och välfärd. Högskolan i Jönköping, Hälsohögskolan, HHJ. SALVE (Socialt arbete, Livssammanhang, Välfärd).
    Cedersund, Elisabet
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för beteendevetenskap och socialt arbete. Högskolan i Jönköping, Hälsohögskolan, HHJ. SALVE (Socialt arbete, Livssammanhang, Välfärd).
    Bengtsson, Staffan
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för beteendevetenskap och socialt arbete. Högskolan i Jönköping, Hälsohögskolan, HHJ. SALVE (Socialt arbete, Livssammanhang, Välfärd).
    Reflection in Action: A multi-layered approach. “Cause I am good at that, you are supposed to say what you are good at these days!”Manuskript (preprint) (Annet vitenskapelig)
  • 41.
    Calltorp, Johan
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare.
    How can our health systems be re-engineered to meet the future challenges?: The Swedish experience2012Inngår i: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 74, nr 5, s. 677-679Artikkel i tidsskrift (Fagfellevurdert)
  • 42.
    Castelpietra, Giulio
    et al.
    Primary Care Service Area, Friuli Venezia Giulia Region, Trieste, Italy.
    Salvador-Carulla, Luis
    Centre for Mental Health Research, Australian National University (ANU), Canberra, Australia.
    Almborg, Ann-Helene
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Nordic WHO-FIC Collaborating Centre, Oslo, Norway.
    Fernandez, Ana Isabel
    Community Health Service, Public Health Agency of Barcelona, Barcelona, Spain.
    Madden, Richard Cawley
    National Centre for Classification in Health, University of Sydney, Australia Received 8 August 2017; accepted 9 October 2017 Available online 7 November 2017 KEYWORDS Mental.
    Working draft: Classifications of interventions in mental health care. An expert review2017Inngår i: European Journal of Psychiatry, ISSN 0213-6163, E-ISSN 2340-4469, Vol. 31, nr 4, s. 127-144Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background and objectives: Specific classifications of mental health interventions have encountered many issues in their integration into a general classification of interventions. Nonetheless, there has not been any previous review on the content and structure of current classifications in relation to mental health care. This expert review aimed to compare the mental health interventions provided in a series of reference classification systems for the incorporation of mental health care into the International Classification of Health Interventions (ICHI).

    Methods: Twelve classifications are described with regards to the structure of the classification (unit of analysis, sections, multiaxiality, granularity) and context of utilization (purpose, descriptors, neutrality, interoperability and implementation).

    Results: Major problems identified include a granularity unbalance (i.e. differences in the number of codes and its specificity with other areas such as rehabilitation), unclear units of analysis (i.e. differences between procedures, interventions, packages of care and care programs), lack of clearly stated evidence-based interventions in a mental health context; and lack of a well-defined taxonomical tree. An ontology approach to the definition of the different entities involved in the throughput of mental care, including their hierarchical relationships and conceptual map, may have contributed to the failure of previous systems together with the development of systems to classify mental health interventions separate from generic health interventions.

    Conclusions: The present review provides additional ground for the development of the ICHI knowledge-base and highlights the importance of taxonomical disambiguation and international comparability in the development and implementation of classifications of mental care interventions. 

  • 43.
    Clarke, David
    et al.
    Academic Unit of Elderly Care and Rehabilitation, Leeds Institute of Health Sciences, Bradford, United Kingdom.
    Jones, Fiona
    Faculty of Health Social Care and Education, St George's University of London, London, United Kingdom.
    Harris, Ruth
    Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, United Kingdom.
    Robert, Glenn
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, United Kingdom.
    What outcomes are associated with developing and implementing co-produced interventions in acute healthcare settings?: A rapid evidence synthesis2017Inngår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, nr 7, artikkel-id e014650Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background

    Co-production is defined as the voluntary or involuntary involvement of users in the design, management, delivery and/or evaluation of services. Interest in co-production as an intervention for improving healthcare quality is increasing. In the acute healthcare context, co-production is promoted as harnessing the knowledge of patients, carers and staff to make changes about which they care most. However, little is known regarding the impact of co-production on patient, staff or organisational outcomes in these settings.

    Aims

    To identify and appraise reported outcomes of co-production as an intervention to improve quality of services in acute healthcare settings.

    Design

    Rapid evidence synthesis.

    Data sources

    Medline, Cinahl, Web of Science, Embase, HMIC, Cochrane Database of Systematic Reviews, SCIE, Proquest Dissertation and Theses, EThOS, OpenGrey; CoDesign; The Design Journal; Design Issues.

    Study selection

    Studies reporting patient, staff or organisational outcomes associated with using co-production in an acute healthcare setting.

    Findings

    712 titles and abstracts were screened; 24 papers underwent full-text review, and 11 papers were included in the evidence synthesis. One study was a feasibility randomised controlled trial, three were process evaluations and seven used descriptive qualitative approaches. Reported outcomes related to (a) the value of patient and staff involvement in co-production processes; (b) the generation of ideas for changes to processes, practices and clinical environments; and (c) tangible service changes and impacts on patient experiences. Only one study included cost analysis; none reported an economic evaluation. No studies assessed the sustainability of any changes made.

    Conclusions

    Despite increasing interest in and advocacy for co-production, there is a lack of rigorous evaluation in acute healthcare settings. Future studies should evaluate clinical and service outcomes as well as the cost-effectiveness of co-production relative to other forms of quality improvement. Potentially broader impacts on the values and behaviours of participants should also be considered. 

  • 44. Dellve, Lotta
    et al.
    Wikström, Ewa
    Tengblad, Stefan
    Liff, Roy
    Andersson, Tomas
    Arman, Rebecka
    Tengelin, Ellinor
    Studiematerial: Hållbart chefskap i hälso- och sjukvården - med vinjetter om engagemang, stress, tidsanvändning, medarbetarskap och vårdpraktik [Elektronisk resurs]2012Rapport (Annet vitenskapelig)
  • 45. Desai, A.
    et al.
    Zoccatelli, G.
    Adams, M.
    Allen, D.
    Brearley, S.
    Rafferty, A. M.
    Robert, Glenn
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Department of Adult Nursing, Florence Nightingale Faculty of Nursing and Midwifery, King’s College London, United Kingdom.
    Donetto, S.
    Taking data seriously: The value of actor-network theory in rethinking patient experience data2017Inngår i: Journal of Health Services Research and Policy, ISSN 1355-8196, E-ISSN 1758-1060, Vol. 22, nr 2, s. 134-136Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Hospitals are awash with patient experience data, much of it collected with the ostensible purpose of improving the quality of patient care. However, there has been comparatively little consideration of the nature and capacities of data itself. Using insights from actor-network theory, we propose that paying attention to patient experience data as having agency in particular hospital interactions allows us to better trace how and in what circumstances data lead (or fail to lead) to quality improvement.

  • 46.
    Dobson, Roy Thomas
    et al.
    University of Saskatchewan.
    Stevenson, Katherine
    Health Quality Council, Saskatoon, Saskatchewan.
    Busch, Angela
    University of Saskatchewan.
    Scott, Darlene J.
    Saskatchewan Institute of Applied Science and Technology.
    Henry, Carol
    University of Saskatchewan.
    Wall, Patricia A.
    University of Saskatchewan.
    A quality improvement activity to promote interprofessional collaboration among health professions students2009Inngår i: American Journal of Pharmaceutical Education, ISSN 0002-9459, E-ISSN 1553-6467, Vol. 73, nr 4, s. 1-7, artikkel-id 64Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVES: To develop and evaluate a classroom-based curriculum designed to promote interprofessional competencies by having undergraduate students from various health professions work together on system-based problems using quality improvement (QI) methods and tools to improve patient-centered care.

    DESIGN: Students from 4 health care programs (nursing, nutrition, pharmacy, and physical therapy) participated in an interprofessional QI activity. In groups of 6 or 7, students completed pre-intervention and post-intervention reflection tools on attitudes relating to interprofessio nal teams, and a tool designed to evaluate group process.

    ASSESSMENT: One hundred thirty-four students (76.6%) completed both self-reflection instruments, and 132 (74.2%) completed the post-course group evaluation instrument. Although already high prior to the activity, students' mean post-intervention reflection scores increased for 12 of 16 items. Post-intervention group evaluation scores reflected a high level of satisfaction with the experience.

    CONCLUSION: Use of a quality-based case study and QI methodology were an effective approach to enhancing interprofessional experiences among students.

  • 47. Donetto, S.
    et al.
    Malone, M.
    Sayer, L.
    Robert, Glenn
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Florence Nightingale Faculty of Nursing & Midwifery, King's College London, United Kingdom.
    New models to support the professional education of health visitors: A qualitative study of the role of space and place in creating ‘community of learning hubs’2017Inngår i: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 54, s. 69-76Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background

    In response to a policy-driven workforce expansion in England new models of preparing health visitors for practice have been implemented. ‘Community of Learning hubs’ (COLHs) are one such model, involving different possible approaches to student support in clinical practice placements (for example, ‘long arm mentoring’ or ‘action learning set’ sessions). Such models present opportunities for studying the possible effects of spatiality on the learning experiences of students and newly qualified health visitors, and on team relationships more broadly.

    Objectives

    To explore a ‘community of learning hub’ model in health visitor education and reflect on the role of space and place in the learning experience and professional identity development of student health visitors.

    Design

    Qualitative research conducted during first year of implementation.

    Settings

    Three ‘community of learning hub’ projects based in two NHS community Trusts in London during the period 2013–2015. Participants Managers and leads (n = 7), practice teachers and mentors (n = 6) and newly qualified and student health visitors (n = 16).

    Methods

    Semi-structured, audio-recorded interviews analysed thematically.

    Results

    Participants had differing views as to what constituted a ‘hub’ in their projects. Two themes emerged around the spaces that shape the learning experience of student and newly qualified health visitors. Firstly, a generalised need for a ‘quiet place’ which allows pause for reflection but also for sharing experiences and relieving common anxieties. Secondly, the role of physical arrangements in open-plan spaces to promote access to support from more experienced practitioners.

    Conclusions

    Attention to spatiality can shed light on important aspects of teaching and learning practices, and on the professional identities these practices shape and support. New configurations of time and space as part of educational initiatives can surface new insights into existing practices and learning models. 

  • 48. Donetto, S.
    et al.
    Penfold, C.
    Anderson, J.
    Robert, Glenn
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare. Högskolan i Jönköping, Hälsohögskolan, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, United Kingdom.
    Maben, J.
    Nursing work and sensory experiences of hospital design: A before and after qualitative study following a move to all-single room inpatient accommodation2017Inngår i: Health and Place, ISSN 1353-8292, E-ISSN 1873-2054, Vol. 46, s. 121-129Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The embodied experience of nursing practice is rarely studied. Drawing on data from an internationally relevant larger study conducted in 2013–14, here we explore the sensory dimension of the embodied experiences of nursing staff working on two acute NHS hospital wards before and after a move to all-single room inpatient accommodation. We undertook a secondary analysis of 25 interviews with nursing staff (12 before and 13 after the move with half [13/25] using photographs taken by participants) from a mixed-method before-and-after study. This analysis focused on the sensory dimensions of nursing staff's experiences of their working practices and the effect of the built environment upon these. Drawing on Pallasmaa's theoretocal insights, we report how the all-single room ward design prioritises ‘focused vision’ and hinders peripheral perception, whilst the open ward environment is rich in contextual and preconscious information. We suggest all-single room accommodation may offer staff an impoverished experience of caring for patients and of working with each other. 

  • 49.
    Donlagic, Amira
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare.
    Lärdomar från SBAR-verktygets införande. En förbättring av samverkande sjukvård?2015Independent thesis Advanced level (degree of Master (Two Years)), 20 poäng / 30 hpOppgave
  • 50.
    Edberg, Lina
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare.
    Förbättrad informationsöverföring i äldreomsorg: - en fallstudie om implementering av ett modifierat SBAR-verktyg2018Independent thesis Advanced level (degree of Master (Two Years)), 80 poäng / 120 hpOppgave
    Abstract [sv]

    Brister i kommunikation är den enskilt största orsaken till att avvikelser inträffar i hälso-och sjukvård. Genom att standardisera kommunikation och informationsöverföring minskar variationen, och logik och ömsesidig överenskommelse skapas.

     

    Syftet med förbättringsarbetet var att öka patientsäkerheten genom att förenkla kommunikationen inom teamet på ett vård-och omsorgboende, genom att införa kommunikationsverktyget SBAR. Den efterföljande studien syftade till att undersöka hur SBAR upplevs inom äldreomsorgen, och vad som kan vara framgångsfaktorer och fallgropar vid införande.

     

    Action research har tillämpats och en innehållsanalys har utförts efter fokusgruppsintervjuer.

     

    Verksamheten såg en positiv utveckling av förbättrad informationsöverföring men nådde inte upp till de uppsatta målen. SBAR upplevdes användbart när de professionella hade fått praktisk träning. De professionella kände en ökad trygghet då den muntliga rapporteringen kombinerades med skriftlig rapportering. Projektet skapade gemensamt lärande genom deltagande observationer. Projektet gjorde att de omgivande strukturerna blev tydligare för personalgruppen och informationsöverföringens fokus lyftes från individnivå till systemnivå. SBAR-strukturen förenklades något för att passa bättre i den flerspråkiga kontexten. Nya områden för förbättring identifierades och en aktivitetstavla skapades. Att hålla jämn utbildningstakt och utbilda vikarier var en utmaning i projektet.

     

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